Organization
KESEWA SAFE HAVEN
Active
Other names
N/a
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NANA A BAMFO LMFT (LICENSED MARRIAGE THERAPIST)
(909) 997-5863
Entity
Organization
Contact information
Practice address
229 S RIVERSIDE AVE, RIALTO, CA 92376-6467
(190) 999-7586
Mailing address
520 W MESA AVE, RIALTO, CA 92376-3285
(909) 997-5863
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251K00000X
Public Health or Welfare Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
251T00000X
PACE Provider Organization
—
—
252Y00000X
Early Intervention Provider Agency
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
05/24/2023
Last updated
05/24/2023
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